Septic Coagulopathy: Pathophysiology, Diagnosis, and Therapeutic Strategies

IF 3.1 4区 医学 Q2 INFECTIOUS DISEASES Current Infectious Disease Reports Pub Date : 2024-01-22 DOI:10.1007/s11908-024-00833-z
Toshiyuki Karumai, Yuki Kotani, Ryohei Yamamoto, Mayuko Tonai, Yoshiro Hayashi
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Abstract

Purpose of Review

Septic coagulopathy is a complex disorder linked with multiple organ dysfunction and increased mortality, and definitive treatments are still lacking. This review summarizes the current understanding of septic coagulopathy, covering its pathophysiology, diagnosis, and debatable treatment approaches. Additionally, it provides a thorough overview of recent research and emerging trends in this area.

Recent Findings

Recent studies have highlighted the interplay between coagulation mechanisms in sepsis and inflammatory response. Diagnostic tools include the newly published scoring system for sepsis-induced coagulopathy and the existing scoring systems for disseminated intravascular coagulation, enhancing early detection and treatment. Several drugs targeting abnormal clotting have been investigated in septic coagulopathy or wider septic groups, including heparin, antithrombin, activated protein C, and human-soluble thrombomodulin. However, they have not yielded clear survival benefits. Nonetheless, recent studies indicate that some of those therapies may benefit specific groups with septic coagulopathy, emphasizing the growing interest in emerging biomarkers and precision medicine to enhance patient outcomes.

Summary

Despite recent advancements, no pharmaceutical intervention is currently endorsed for septic coagulopathy. However, a noted association exists between disseminated intravascular coagulation and unfavorable prognosis. Future research is imperative, especially in devising individualized treatment strategies tailored to each patient’s condition.

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化脓性凝血病:病理生理学、诊断和治疗策略
综述目的脓毒症凝血病是一种复杂的疾病,与多器官功能障碍和死亡率增加有关,目前仍缺乏明确的治疗方法。本综述总结了目前对脓毒症凝血病的认识,涵盖其病理生理学、诊断和备受争议的治疗方法。最近的研究强调了脓毒症和炎症反应中凝血机制之间的相互作用。诊断工具包括新出版的脓毒症诱发凝血病评分系统和现有的弥散性血管内凝血评分系统,从而加强了早期检测和治疗。针对脓毒症凝血病或更广泛的脓毒症群体,已经研究了多种针对凝血异常的药物,包括肝素、抗凝血酶、活化蛋白 C 和人溶性血栓调节蛋白。然而,这些药物并没有为患者带来明显的生存益处。尽管如此,最近的研究表明,其中一些疗法可能会使特定的脓毒症凝血病群体受益,这凸显了人们对新兴生物标志物和精准医疗以提高患者预后的兴趣与日俱增。然而,弥散性血管内凝血与不良预后之间存在着明显的关联。未来的研究势在必行,尤其是针对每位患者的病情制定个性化的治疗策略。
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来源期刊
Current Infectious Disease Reports
Current Infectious Disease Reports INFECTIOUS DISEASES-
CiteScore
6.70
自引率
0.00%
发文量
19
期刊介绍: This journal intends to provide clear, insightful, balanced contributions by international experts that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of infectious disease. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as HIV/AIDS, sexually transmitted diseases, tropical and travel medicine, and urinary tract infections. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists.
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